PCL reconstruction is a surgical procedure that is used to rebuild a PCL by replacing it with another tendon since it is one of the four important ligaments that hold the knee joint in place. The PCL is a ligament that keeps the tibia from moving too far back in comparison to the femur. PCL injuries are not as frequent as ACL injuries but they can cause instability of the knee joint and functional deficits.

Indications for PCL Reconstruction

·        Complete PCL tears (grade III), where the ligament is fully ruptured.

·        Long-standing PCL deficiency resulting in instability, pain, and weakness.

·        Multiple ligament injuries, where other knee ligaments such as the ACL or MCL are also affected.

·        Symptoms that remain unaltered or recur even after undergoing conservative measures like physiotherapy and using braces.

Surgical Procedure

1.     Preoperative Planning: Physical examination, MRI scan and maybe stress X-rays to establish the extent of injury and prepare for the surgery.

2.     Anesthesia: General or regional anaesthesia is given.

3.     Arthroscopy: Keyhole surgery is done in which a small camera called an arthroscope and surgical instruments are inserted into the knee.

4.     Graft Selection: A graft, most commonly taken from the patient’s hamstring tendons, quadriceps tendon or from a donor (allograft) is then obtained.

5.     Tunnel Creation: Holes are made in the tibia and femur at the points where the PCL is attached to the bone.

6.     Graft Placement: The graft is passed through the tunnels and fixed with screws or other fixation devices to mimic the native PCL.

7.     Closure: The cuts are made, and the knee is wrapped up.

Postoperative Care and Rehabilitation

·        Immediate Postoperative Period: Rice: rest, ice, compression, and elevation to minimize swelling and pain. Wearing a knee brace to prevent damage to the reconstructed ligament.

·        Physical Therapy: A stepwise approach including range of motion exercises, strengthening exercises, and stability exercises in a rehabilitation program. Return to weight-bearing activities as tolerated.

·        Timeline: The healing process may take from several months up to a year, depending on the extent of the injury and the strict compliance with the recommended rehabilitation program.

Risks and Complications

·        Infection: Like with any other surgery, there is always a possibility of infection.

·        Graft Failure: The new ligament may not gain proper strength or may get injured again.

·        Knee Stiffness: It may result in the formation of scar tissue which limits movement.

·        Pain: Cravings around the knee joint or where the graft was taken from.

·        Deep Vein Thrombosis (DVT): Deep vein thrombosis occurs when blood clots develop in the leg veins after surgery.


·        Good outcomes of PCL reconstruction include increased stability of the knee joint, reduction of pain, and resumed physical activities, including sports.

·        The results of the procedure in the long run will be determined by the intensity of the injury, the type of graft used, the accuracy of the surgical procedure, and the patient’s adherence to the physiotherapy regimen.


PCL reconstruction is a complex surgery designed to reestablish knee stability and functionality following severe PCL damage. Surgical procedures and postoperative care have been enhanced in recent years, enabling many patients to regain normal or near-normal function.